Senior Quality Improvement Specialist, Behavioral Health

Overview

Supports interdepartmental Quality Improvement (QI) initiatives focused on promoting high-quality, safe, and equitable member care. Serves as a clinical and operational resource to QI committees, workgroups, and leadership. Analyzes outcomes, HEDIS/CAHPS/Stars performance, and trend data to identify opportunities for improvement in care coordination, quality, and member experience. Designs, implements, and evaluates QI programs aligned with DOH, CMS, and NCQA standards. Collaborates across departments-including Care Management, Utilization Management, Provider Relations, Compliance, and Analytics-to sustain continuous improvement, advance health equity, and ensure regulatory readiness.

What We Provide

• Referral bonus opportunities

• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability

• Employer-matched retirement saving funds

• Personal and financial wellness programs

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

• Generous tuition reimbursement for qualifying degrees

• Opportunities for professional growth and career advancement

• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Supports Behavioral Health (BH) provider engagement efforts, with a focus on leveraging performance data to support provider improvement and enhance value delivered to VNS Health members.
• Drives year over year BH provider performance improvement through targeted education, coaching, and data.
• Establishes strong relationships with BH providers and supports measurable improvements in clinical quality, access, and member outcomes.
• Collaborate with internal clinical, quality, and network teams to advance HEDIS performance and achieve clinical, quality, and network improvement goals.
• Creates and maintains linkages between providers of all levels of care, as well as other community-based services and resources to improve transitions of care and continuity of services.
• Partners with network providers and Carelon stakeholders to operationalize innovative programs, tools, and online resources to improve BH quality outcomes.
• Identifies opportunities for new or expanded BH initiatives, pilot programs, and supports planning, implementation, and evaluation of their impact.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications:

• License and current registration to practice as a LCSW, LMFT, LMHC, LPC, or Licensed Psychologist in New York State or New Jersey required

Education:

• Master's Degree in Social Work or other Behavioral Health field required

Work Experience:

• Minimum of five years experience in a health plan or health care setting required
• Minimum of four years quality improvement experience required
• Minimum of two year experience, quality management, practice improvement and compliance required
• Demonstrated experience leading or facilitating cross-functional quality initiatives required
• Excellent oral, written and interpersonal communication skills, including group facilitation skills required
• Knowledge of basic Performance Improvement tools and methodologies (e.g., PDSA, LEAN, Six Sigma). preferred
• Experience applying data analysis to clinical and operational improvement strongly desired. preferred

Pay Range

USD $93,400.00 - USD $116,800.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.